Confounded By ICD-10 Excludes1 Notes? Here’s Why
The National Center for Health Statistics (NCHS), the federal agency responsible for the use of the newly-implemented ICD-10 diagnosis code set in the United States, posted interim advice on its website concerning the interpretation of Excludes1 notes.
VitalWare, LLC, reports in its October 26 issue of VitalAlert™, “There may be instances where conditions currently included in Excludes 1 notes should be coded in addition to the diagnosis code on which the Excludes 1 note appears.” In other words, there may be conditions currently included in an Excludes1 note that belong in an Excludes2 note.
In response, the NCHS posted this interim advice:
“If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note.
For example, the Excludes1 note at code range R40-R46, states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes. However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and bipolar disorder.
In another example, code range I60-I69 (Cerebrovascular Diseases) has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I69-.”
Changes to Excludes notes or revisions to the official coding guidelines cannot be made until October 2016. Until then, “The new guidance concerning Excludes 1 notes is intended to allow conditions to be reported together when appropriate even though they may currently be subject to an Excludes 1 note,” said VitalWare, LLC.
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